RCOT Annual Conference 2022 – highlights from day one

In an inspirational opening session that resonated with everyone watching, Lyndsey Barrett, Director and Lead Occupational Therapist of Sport for Confidence CIC, talked about her practice experiences and leadership journey, with a focus on applying an occupational perspective to tackling inequalities in physical activity participation.

‘Occupational therapy is my absolute passion,’ she told delegates while reflecting on her own lived experience of being diagnosed with a rare auto-immune disease with a 98% fatality rate that saw her spend a year in hospital as an occupational therapy student.

Prior to this, Lyndsey had played netball for England in the Under 21 squad, but ‘overnight’ she went from athlete to not being able to stand, hold a drink or clean her teeth.

Being on the receiving end of occupational therapy has clearly shaped Lyndsey’s career pathway and leadership journey, and through establishing Sport for Confidence she has extended occupational therapy practice into mainstream community-based settings, such as leisure centres.

But despite being co-founder of the charity, and the service growing in seven years from seeing just two people a week to over 3,000 a month in leisure centres across Essex and London, imposter syndrome has been a real challenge.

In a searingly honest reflection on how she has dealt with imposter syndrome during her career she said: ‘I have to look back – especially when I am faced with challenges related to leadership – and see what’s been achieved, rather than looking ahead, because while it is important to look ahead there are times when it feels completely overwhelming.’

She added: ‘I have to hold on tightly to certain things I know that ground me. And one of the important things is being able to hold unswervingly to knowing what my scope of practice is, so that I know that I am using sport and physical activity therapeutically to enhance occupational performance.’

‘I also know that our professional rationale for any intervention or activity, whether I’m in a diverse setting or not, is the enhancement of health and wellbeing through the promotion of occupational performance, engagement and participation in life roles. That’s in our professional code of conduct… so I know I am 100% where I am meant to be, and that occupational therapy adds so much value in this space.’

She went on: ‘I am very much shouting about what happens when we reimagine physical activity from an occupational perspective, [and] what can be achieved when we truly put people at the centre of what we do, when we consider the environment and the relevance of those activities in people’s lives.’

Her take home message about the work she is doing with Sport for Confidence, and the recent system partnership investment from Sport England, was: ‘We are able to create opportunities for people to receive occupational therapy in a place they can return to. You never get discharged from a leisure centre.’

wo years after having gone into hospital with COVID-19, where he was placed into an induced coma for 40 days, Michael Rosen, acclaimed children's author and poet, inspired the occupational therapy community by sharing his recovery story in our second Plenary session today, ‘My very own bear hunt: a journey back from COVID’.

The ‘game changer’ for Michael’s first leg of his recovery journey, while he was delirious and resisting coming out of his coma, was his wife Emma, who played recordings of their children to him on her phone.  

The next step was Michael experiencing both occupational therapy and physiotherapy for the first time on the geriatric ward he’d been transferred to for his first round of recovery.

Unable to stand up and gasping for air, as he was experiencing severe breathing difficulties, and trying to ‘mend’ his disturbed mind, as he didn’t understand what was going on, Michael told delegates he became extremely unhappy and desperately wanted to go home. Which of course he couldn’t.

From here, he was sent to St Pancras Rehabilitation Hospital. ‘Emma really sold this to me… and said they would teach me how to walk again,’ he said. ‘I just thought, well that’s a nice thing to say, but it isn’t going to happen.’

Referring to the rehabilitation centre as ‘wonderful’ and ‘the opposite of Amy Winehouse… I will go to rehab, yes, yes, yes!’, Michael described how the therapists ‘taught me everything’ on an ‘incredible adventure and experience’.

He added: ‘I can remember that first experience, where a group of you came to my bedside… and you said you’re going to get up now, and me just thinking of course I’m not, I can’t do that.’  

But over the following three weeks, with what he calls ‘a hard cop, soft cop’ method from the therapists, he made remarkable progress. ‘I [got] myself into a mindset that this is all about me getting better,’ he reflected.  

In rehab, and with the support of and exercises from his therapists, he progressed from not being able to stand up, let alone walk, to using a Zimmer frame, a wheelchair and then a walking stick, which he humorously labelled ‘Sticky McStickstick’ and has based his new children’s book on.  

And after three weeks, he was able to make the walk from the ambulance to his front door without using a walking aid.

‘At each stage [of the rehab journey] I thought maybe that’s it now for the rest of my life? But of course, you weren’t having that! Through all these stages [you] made it clear that this was about me becoming independent.’

‘That word is very, very important to me and I remember formulating it that the medics had helped me to get better, but you were helping me to help myself.’

Michael is now taking five 30-minute walks a week. ‘I owe you folks so much,’ he concluded emotionally. ‘Thank you.’

In a powerful session on the path towards LGBTQIA+ belonging in the occupational therapy profession, delegates heard that to become a better ally, you need to listen more, educate yourself and practise self-reflection, avoid assumptions and have the confidence to ask questions.  

Sue Kenney, a lecturer at Coventry University and the acting chair of the RCOT LGBTQIA+ Steering Group, told delegates that to be in the position of someone who identifies as LGBTQIA+ and to always be the one who is questioning the status quo is ‘hard work and quite exhausting’.  

One of the ways that people can become a true ally, she went on, is to also question the status quo and ‘take up some of the slack’ of that work on behalf of the LGBTQIA+ community. She stressed that that there’s ‘power’ in people coming together to ask the questions.

She also urged people to ‘beware of the single story’; in other words, don’t always assume that one person is going to be able to speak on behalf of everybody.

Rachel Daniels, specialist occupational therapist at Coventry and Warwickshire Partnership Trust and a founding member of the wider affinity group LGBTQIA+OTUK, added that one thing she is continuing to learn is that it’s difficult to get people in power to listen to one or two people.  

‘But actually, if you go as a collective,’ she said, ‘and almost make it that you can’t be ignored, because there are so many of you, well that’s why we are here today.’   

Linking that back to occupational therapy itself, Hannah Spencer, an NHS occupational therapist and a founding member of LGBTQIA+OTUK, added: ‘All these things we’re encouraging people to do towards LGBTQIA+ inclusion and belonging [and] the support in our environment to be our authentic selves, and not to have to fight to edit ourselves in order to fit in, they are environmental adaptations. That’s occupational therapy’s game.’

The session offered a space for acknowledgement and celebration of the LGBTQIA+ community within our profession and the speakers stressed that, in the UK, acknowledgment of and visible commitment to understanding the LGBTQIA+ community in occupational therapy has been historically poor.  

Acknowledging the need for overdue change and looking back with pride at the progress made over the past year, the speakers charted the development of the LGBTQIA+OTUK affinity group, before focusing on how members have negotiated some ‘challenging conversations’ and have begun work alongside RCOT to establish a means for increasing LGBTQIA+ visibility, inclusion and belonging in our profession and professional body.

In a thought-provoking and impactful presentation, Sheherazad Kapadia discussed the findings of her MSc study, which examined how occupational therapy practitioners and students from Black, Asian and Minoritized Ethnic Backgrounds in the UK have experienced race-based Type II Workplace Violence.

She referred to shocking data from NHS England’s Race Equality Standards that shows 30% of AHPs from Black, Asian and Minoritized Ethnic Backgrounds faced harassment and abuse from clients.

Sheherazad described how her study’s literature review indicated that little is known about the phenomenon of Type II Workplace Violence specific to occupational therapists. Thus, her study set out to try to better understand the numerous ways in which racism persists, despite legislation.  

Ten participants were asked to share incidences describing covert or overt racism and the study identified three main themes: the persistent racialisation of practitioners and students of Black, Asian and Minoritized Ethnic Backgrounds; the prioritisation of professionalism; and institutional failings.

The study found that participants characterised overt racism as having obvious actions, while covert racism was described as more of a feeling or sensing of racism. But for both, there were very harmful assumptions underpinning racism, ‘usually about one’s accent or belonging,’ and these had an impact on the wellbeing of those occupational therapy practitioners and students.

‘For both covert and overt racism, what we saw was the normalisation of racism and that these instances were sometimes everyday common occurrences,’ she said.

When it came to the theme of upholding professionalism, Sheherazad said that participants often adopted a ‘client first’ approach, often having to continue working with a client ‘despite the racism and violence they had been confronted with.’  

Participants spoke about ‘resilience,’ she said, ‘and it appeared that there’s an implicit expectation for Black and Asian professionals to brush over these incidences and get on with their jobs.’

The findings around the third theme indicated that participants felt that there was ‘no attempt by senior staff to tackle endemic racism’ and that little was done to address racism. ‘Individuals often felt like they had nowhere to go, and no-one would believe them,’ she asserted.

She concluded by saying the three emergent themes of the study have a ‘cyclical flow,’ which begins with the ‘privileged view of racism’ whereby racism is perceived to be not normal and is ‘only done by a few bad eggs.’

As a result, she said, ‘we lack a social responsibility’ and we ‘adopt short term fixes’ to quickly solve the problem.  

‘We then have genuine feelings of mistrust and disbelief between those experiencing the racism, sometimes daily, and those who it is being reported to,’ she added, ‘[while] at the same time individuals do not want to be seen as “playing the race card”.’

This in turn leads to lack of reporting and institutions feeling that they do not have to act, as they remain ignorant to everyday racism, maintaining the privileged view that racism is uncommon.

As part of RCOT’s Improving Lives, Saving Money campaign, in 2019 we produced a key report that recommended occupational therapists should advise on the design of prison environments, to enable vulnerable prisoners to engage in rehabilitation, educational and vocational services.

In a collaborative panel discussion comprised of occupational therapists and HM Prison and Probation Service (HMPPS) leaders, talked about a project they are working on together around national regime changes within the prison systems across England and Wales.

The Future Regime Design Team involves designing a regime that delivers the right service, to the right person, at the right time (increased personalisation) and making every activity matter (reconceptualising purposeful activity).  

Emma Nicklin, Associate Director of Allied Health Professions Trust wide Head of Profession for Occupational Therapy, Central and North West London NHS Trust, kicked off discussion.  

‘The occupational needs of prisoners are really obvious when you step foot in a prison,’ she said. ‘You can see the impact of a lack of meaningful occupation and how deprived occupationally the prison service is.’

She explained how occupational therapists ‘can really see people’s strengths’ and used an example of working with ‘heavy duty drug dealers’ in prisons, who are ‘hugely skilled in their communication and business management [and] in the way they negotiate that world’.  

As an occupational therapist, she stressed, you can really understand how those skills can be used differently and in a pro-social way. ‘The link between stopping re-offending and meaningful occupation is really obvious.’

With a vision for doing things differently and a drive to changing the system, she told delegates that having the language and confidence to talk to leaders is vitally important, alongside finding allies to support you in changing the system and having influence.

Emma Holmes, Lead Occupational Therapist for Health and Justice Services, Central and North West London NHS Foundation Trust, added: ‘Thinking outside the box and being creative is so important to bringing about change. If you see how things are done, it’s healthy to question that [and ask] is this the right way to do it in a non-threatening way?’  

She added: ‘We all have the ability to influence.’

Chris Gunderson, Head of HMPPS Future Regime Design (FRD), Transforming Delivery in Prisons Programme, HMPPS, joined the discussion to talk about the project aims and the Time Well Spent vision.  

He said: ‘It’s ambitious. It’s all around the right services to the right person, it’s all about greater personalisation and it’s about not just doing activities that appear to offer a value to everybody and to make judgements that everybody needs the same, but to replicate the things we need in society, but in a personalised way.’  

Jennifer Stickney, Advanced Occupational Therapy Practitioner at STRIVE, advised anyone who wants to exert real influence to be ‘passionate’ about the area you are working in, and that ‘believing that what you are doing is going to make a significant difference helps other people to see that too.’

She urged people to ‘seize every opportunity’ and to work flexibly and creatively and to be an advocate of the profession and look at how your environment can change for the better.  

Her key message was to ‘understand your allies and how you can create relationships with them and try to understand the politics of what’s going on around you, so you can pitch yourself in the right place at the right time.’  

She concluded: ‘Be aware of other people’s agendas around you and use this so you can make headway in what you are doing... and finally, just love what you do, because if you love it, other people will do too.’